If enrolled, will you request to be an on-campus residential student?
Yes
No

PERSONAL

STUDENT INFORMATION

Sal.

Mr.
Ms.

First Name

Middle Name

Last Name

Preferred Name

Date of Birth

(MM/DD/YYYY)

Place of Birth

Social Security Number

CONTACT INFORMATION

E-mail

Home address

City, State, Zip

Country

Mailing address (if different)

City, State, Zip

Country

Phone

Cell Phone

EMPLOYMENT INFORMATION

Employer

Current Position

Work Phone

Work Fax

LICENSURE

Do you currently possess a valid teaching license?
Yes
NoIf yes, indicate the licensing state.

CITIZENSHIP

Are you a U.S. citizen?
Yes
No

If no, then please answer the questions below...

What is your country of citizenship?

Are you a permanent U.S. resident?
Yes
No
Number of years in U.S.

Is English your first language?
Yes
No

OPTIONAL

Responses to questions about your race, your
first language (if other than English), the
language spoken in your home, family, and religion
help us monitor our success in attracting a diverse
group of applicants to Randolph. Your answer
to any of these questions, or your decision not
to respond, does not affect your chances of admission.

If you are a U.S. citizen or U.S. permanent resident, how would you describe yourself?
American Indian or Alaskan Native
Black or African American
Asian American or Pacific Islander
Hispanic
White or Caucasian
Other If other, please specify...

What is your first language, if other than English?
What language do you speak at home?

Religion

EDUCATIONAL

DEGREE INFORMATION

Do you have a bachelor's degree?

Yes
No
Major Field of Study

Do you have an associate's degree?

Yes
No

Name of institution granting degree

Completion Date

GPA at time of application (if known)

TEST SCORES

PRAXIS

Reading
Writing
Math
Date Taken

SAT

Total
Verbal
Math
Date Taken

PROFESSIONAL COURSEWORK

Please list/describe any professional courses
you have completed along with any grades you
received.

SCHOOLS ATTENDED

Higher Education

College/University

City/State

From M/Y to M/Y

High School

Name of High School

City/State

Graduation year

or GED

City/State

M/Y Awarded

Please provide your former name(s) at the time of attendance at
above institutions that will appear on transcripts from these institutions:

How did you learn about the master's program
at Randolph?

ESSAY

Please submit a written statement of 500 words
describing your educational goals and your reasons
for entering the master's degree program. This
statement may be mailed separately or submitted
via e-mail to admissions@randolphcollege.edu.
If you are submitting separately, please indicate
in the box below that you are going to do so.